Medical Device Employees Are Often In The O.R., Raising Concerns About Influence

They are a little-known presence in many operating rooms, offering technical expertise to surgeons installing new knees, implanting cardiac defibrillators or performing delicate spine surgery.

Often called device reps — or by the more cumbersome and less transparent moniker “health-care industry representatives” — these salespeople are employed by the companies that make medical devices: Stryker, Johnson & Johnson and Medtronic, to name a few. Their presence in the OR, particularly common in orthopedics and neurosurgery, is part of the equipment packages that hospitals typically buy.

Many “people who don’t work in health care don’t realize that industry reps are sometimes in the OR,” said Josephine Wergin, a risk management analyst for the ECRI Institute, a Pennsylvania nonprofit that conducts research on medical subjects for the health care industry. “A lot of times they are the real experts on their products.”

Unlike rotating teams of nurses and surgical techs, reps are a consistent presence, experts say, often functioning as uber-assistants to surgeons with whom they cultivate close relationships and upon whom their six-figure salaries depend.

Although they don’t scrub in, reps are expected to be intimately familiar with the equipment they sell, making sure it is at the ready for the surgeon and poised to answer technical questions.

Who’s The Expert?

But how much influence do reps wield, how necessary and costly are their services and does their presence in the OR, which may not be disclosed to patients, raise ethical questions about informed consent? [Read more…]

Dr. Zoe Maher has never been busier. In addition to being a trauma surgeon and a new mom, she’s spent the last year and a half talking to hospital patients and community groups across Philadelphia about a study she’s confident will save more adult gunshot and stab wound victims.

At the heart of the study is a simple but counterintuitive idea. For patients who are potentially bleeding to death, Maher and her colleagues say, basic, stabilizing care is better than more advanced care until they reach the hospital.

To test this, patients in the study would get different medical attention based on the dispatch number city paramedics receive — what’s called a randomized study.

“It’s like the flip of a coin if patients are getting advanced or basic,” said Maher, who works at Temple University Hospital.

People with odd dispatch numbers will get what’s called advanced care, which is what the majority of patients transported by paramedics get now. It includes procedures like inserting a breathing tube or supplying intravenous fluids.

Even numbers will get what’s known as basic care, which can include hemorrhage control, breathing assistance with a bag-valve mask, dressing wounds and aligning bones. They would then be immediately transported to the hospital.

But the idea of assigning types of care randomly got mixed reviews at the community meeting in North Philadelphia. [Read more…]

On the final day of June 2015, Colin LePage rode waves of hope and despair. It started when LePage found his 30-year-old son, Chris, at home after an apparent overdose. Paramedics rushed Chris by helicopter to one of Boston’s flagship medical centers.

Doctors revived Chris’s heart, but struggled to stabilize his temperature and blood pressure. At some point, a doctor or nurse mentioned to LePage that his son had agreed to be an organ donor.

“There was no urgency or, ‘Hey, you need to do this.’ I could see genuine concern and sadness,” LePage said, his voice quavering.

The next morning, after another round of tests showed no signs of brain activity, LePage said goodbye to the son who’d been revived but wasn’t fully alive.

“I sat in a chair with him and held his hand,” LePage said. “It wasn’t clinical. It didn’t feel like someone’s gaining something here. I knew that someone was, and that’s comforting that someone else has been able to have a little piece of my son and some of their pain is not what it used to be.”

Chris’s liver is now working in the body of a 62-year-old pastor. His case is one among the nearly nine-fold increase so far in donations from drug users across New England since 2010. So far this year, more than one in four, or 27 percent, of donations in New England are from people who died after a drug overdose. Nationally, that rate is 12 percent for the same time period.

“It’s remarkable and it’s also tragic,” said Alexandra Glazier, president and CEO of the New England Organ Bank. “We see this tragedy of the opioid epidemic as having an unexpected life-saving legacy.” [Read more…]

It’s long been a problem for the nation’s hospitals: A staggering number of medical supplies — from surgical gloves to sponges to medications — go unused and are discarded after surgeries.

A recent study by researchers at the University of California, San Francisco has put a price tag on that waste: almost $1,000 per procedure examined at the academic medical center.

The research, published in May in the Journal of Neurosurgery, examined 58 neurosurgeries performed by 14 different surgeons at UCSF Medical Center, a leading academic hospital.

James Yoon, one of the principal UCSF researchers on the study, said they weren’t only looking at costs but also at the environmental impact of wasted supplies.

Operating rooms in the U.S. produce more than 2,000 tons of waste per day, he said. Some of it is biological and must be safely disposed of. Part of the research involved identifying which surgeries generated the most waste. Spinal procedures, for example, are among the most wasteful, the researchers found.

They also learned that the length of a surgeon’s experience bore no relation to the volume of squandered supplies. More experienced surgeons were not necessarily more frugal. [Read more…]

War abroad and carnage at home since 9/11 have taught Americans much about saving lives after violent tragedies.

Whether they were hurt in mass shootings or gruesome car accidents, it’s not uncommon for victims to bleed to death on the scene because trained assistance didn’t arrive in time to help them.

But one of the most powerful initiatives in trauma care in the past 15 years might make a difference.

Across the country, a public safety campaign is underway to teach both first responders, such as police officers, and average citizens how to stop trauma victims from bleeding to death.

United under the banner of a White House-led public safety campaign called “Stop The Bleed,” federal agencies, major health care and law enforcement trade associations, local governments and some companies are backing the effort.

The national push for broader training is “a direct descendant of the 9/11 experience,” said Oscar Guillamondegui, medical director of the trauma intensive care unit at the Vanderbilt University Medical Center. [Read more…]

Mario Perez lives in Miami, but he was in Orlando for a housewarming party Saturday, June 11. After the party, the 34-year-old went to the Pulse nightclub for Latin night.

At 2 a.m., he heard gunshots. Loud. He knew it was real.

“And the minute he started shooting, I got hit from the side, I got grazed by a bullet,” Perez said. “My first instinct was to fall to the floor, that’s what you’re taught to do.”

He heard gunshot after gunshot after gunshot — too many to count. But then there was a brief break in the firing, and Perez ran out the back of the club. He hid inside the kitchen of a nearby 7-Eleven until police and paramedics showed up. He was taken to Orlando Regional Medical Center, and was at the emergency room from 3 a.m. until 8 a.m.

The gunshot wound on his side is purple and swollen, and he has nerve damage from the bullet fragment. He cut his elbow from glass on the floor of the nightclub and needed six stitches. Perez doesn’t know how much bills coming from specialists, X-rays and tests might cost him. But his bill from Orlando Regional Medical Center’s emergency department is $20,000.

Dr. Thomas Gallagher has been through many tough conversations with patients. He remembers once standing in front of a patient and the patient’s family, preparing to tell them about a mistake that had occurred.

“This is a topic I think about all the time and it was still very nerve-racking and embarrassing,” said Gallagher, an internist and a professor at the University of Washington’s medical school specializing in quality and patient safety issues.

The patient had been sent to another clinic an hour away to get an MRI, but because of a miscommunication, the MRI was done in the wrong area of the body and would have to be repeated.

“The patient was disgusted,” Gallagher recalled about the event that occurred before he came to Washington. “His family was furious … that after all the patient had gone through to get this test … we still couldn’t even figure out something this basic.”

Medical mistakes often happen. National guidelines call for doctors to provide full disclosure about adverse events, and studies have shown that those discussions benefit patients. But new research finds that the act of disclosure, combined with stress from the procedure gone wrong, can be an anxious experience for some doctors — and more training is needed to help them engage in these difficult conversations.

Doctors cling to comfortable, widely used medical practices, even if they’re no longer particularly effective, right?

A new study disputes that popular perception. In the case of a particular breast cancer treatment at least, many physicians quickly abandoned it after a clinical trial showed it was ineffective. [Read more…]

Tens of thousands of American lives could be saved each year with a concerted national effort to emulate what top military and civilian trauma centers are doing, a prestigious panel of top medical experts reported Friday. [Read more…]

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